All about Knee Replacement

Cummings and Goings

Last summer (2010), the time of reckoning finally came. After 65 years of tennis
plus all the other sports I played, my knees had had it. Shot. Cartilage
gone. Time for knee replacement. It came as no surprise although I was
hoping to get through the summer and be able to play in Cape Cod on
Mid-Atlantic’s 75 Intersectional Team the end of July. Despite knee
discomfort, my game was sharp.

But about a month before the intersectional, I was playing a match at St
Tim’s when I felt a sharp twinge in my left knee and had to stop. The
following week, I went to see Dr. Mike Jacobs at Good Samaritan Hospital.
Mike and I have known each other for at least 20 years; ever since he first
came into the area. He is a good tennis player and back then we hit
together. In the summer of 2009 when Dr. Charles (Chic) Silberstein retired
from his general orthopedic practice, I did not have to look for another
Sports Medicine Orthopedist.

Why a Sports Medicine orthopedist? I’ll answer that with a question Chic
would ask me whenever I had the misfortune to see him professionally and not
on the court: “When is your next tournament?” Sports Medicine Orthopedist
are experienced in athletic injuries and know the psyche of an athlete. Both
Chic and Mike had served as team doctors for the Orioles. I was and am in
the best of hands.

X-rays taken that visit confirmed it was time for knee replacement. Oddly,
Mike said it was OK to keep playing. The knees could not be hurt further. I
left his office with cortisone shots in each knee. A little over two weeks
later, I was playing doubles with Bob Davison and there was not a good knee
between the two of us. It was hard to tell which of us was hobbling worse.
One of our opponents was Ed Fishman who has both hips replaced and we were
joking that Ed was the fastest player on the court. Ed will tell you that he
is faster than ever with his new hips and we have to keep reminding him that
he was never fast to begin with. Steady Eddie, yes. Fast Eddie, No.

It turned out that day, July 14, was the last time I played in 2010. In
addition to the knees, my hip started to pain me and what with the
deterioration of my game, I quit playing cold turkey. In the past, I had a
bad experience when favoring a body part and then having another part go out
of whack. I didn’t need bad hips on top of bad knees.

Getting to the replacement decision was not an overnight thing; not by a
long shot. My first serious knee problem came in 1997 after the finals of a
Century tournament at Perring. Bill Rublee and I came out on top in that
one, but when it was over, my left knee was giving me fits. After surgical
repair, I was fitted with a light metal, no-load knee brace which became
standard equipment until the new knees came along. It looked like an oxy
contraption and in a way it was, but it was properly fitted and wore like a
glove. The brace never gave me a moment’s concern from the first day I put
it on.

The following year at one of Barry Grube’s famous Century tournaments
at Cross Keys, the right knee became a problem. Draining it of fluid and
cortisone were enough to fix it; at least for awhile. I also decided to
limit play on hard courts. Being in my 60s at the time, hard courts were
becoming too hard on my knees. And the good doctor advised me to limit my
play to doubles; comparing my knees to a set of tires that were going bald
and loosing their grip. The more and harder you use them; the quicker you
lose them.

There were other measures I took to preserve my knees as long as I could.
The chief of these was a workout program at a fitness center with emphasis
on leg muscles. Strong quads are a big help in keeping the load off your
knees. So is weight control and although I do not have a weight problem, I
became more conscious of what I ate and how much. Then there were
non-steroidal anti-inflammatory drugs (NSAIDs) to help with the arthritic
joint pain . I had prescriptions for a couple of these, but stopped taking
them because of ulcers and ended up using over-the -counter, low dosage
ibuprofen which worked fine.

One thing Dr. Silberstein had me try was Synvisc (artificial synovial
fluid). Synvisc is now a one-shot deal after which you can start playing
again in a few days, but back then, it was a series of 3 shots a week apart
injected straight into the knees after which it was recommended you not
resume play until a couple weeks after the last shots. It is a relatively
painless procedure, but I’ll warn you ahead of time the needles are long
because the serum is injected into the center of the knee.

My first treatment of Synvisc worked like a charm and for over a year gave
me pain relief, well over the 6 months advertised. The second lasted less
than a year and a third treatment did not do that much good. The inevitable
can only be put off for so long. Next: The Inevitable.

Knee Replacement (Part II)There was never a question whether I was going to have knee replacement.
That was a given. The question was when. The answer became obvious that
morning at Sea Colony I wrote about in my last column. In the second set of
the doubles match Bob Davison and I were playing, we were covering court
like a pair of Frankenstein’s monsters. Both of us were in pain and
thoroughly not enjoying ourselves. We shared a moment of truth. Two days
later I called Dr. Mike Jacobs’ surgery coordinator at Good Samaritan
Hospital to schedule surgery. (Bob would have his knees replaced shortly
after mine).

September 7, 2010 was selected as D-Day for the left knee. The right was
scheduled for a week later. Why a week later? Because that is what the
doctor decided and I saw no reason to question him. I had chosen Mike Jacobs
not only because he is a friend, but also because he is recognized as a top
sports medicine orthopedist. My only input, if you want to call it that, was
that he do whatever it took to get me back on the court and that was
superfluous because that he already knew. How many books could I read or how
much could I learn to put me in a position to make a better, more informed
decision than him? On the other side of that coin, Bob decided to have both
knees done at the same time, but it had nothing to do with the surgery
itself. Bob knew he needed to have both his knees replaced and was concerned
that after going through it once, he might not want to go through it again.
It’s a known phenomena and I admire the decision he made. It is called
biting the bullet.

That call to schedule surgery triggered a number of tests and classes which
had to be scheduled and completed before the surgery. Good Sam wants to
ensure you are healthy enough to have the surgery and that you have a good
idea what it is all about before it. Good Sam does a good job in seeing
that you are prepared, but as good a job as it does, there were surprises.
To give you just one example; shortly after getting home from the hospital
after surgery I sat down at the computer to look at my email. In less than
10 minutes I was fatigued. If you haven’t guessed, there are few good
surprises. This is not a picnic I am writing about.

You will probably need blood during and even after knee replacement. For
several good reasons the best source is your own (and you can donate right
there in the hospital). If at all possible, donate the number of units
recommended by your doctor. Donating blood for most people is simple and
pain free but it does involve a needle. I’ll tell you an unvarnished fact
ahead of time, knee replacement seems to involve a lifetime of needles.
More than once I invoked my “whatever” mantra as I got punctured.

One of the things Russell Fink wrote in Match Point several years ago about
his knee replacement experience was the importance of doing the exercises
you are given before your surgery. It is something I took to heart and am
thankful for it. You are seriously weakened by the surgery and if you go in
weak, getting up and around after surgery will be just that much more
difficult and your rehab will take longer.

For a few months after surgery, there is a lot of down time. You can only
exercise so much; you can only nap so much. Think ahead about how to occupy
this time. Put it to good use to help while away the hours and take your
mind off things. I spent a good deal of mine sifting and winnowing through
10 boxes of archives I brought up from the basement before the surgery. Much
of it went in the recycle, but a lot of history dating back to the 1970s
that might have otherwise been lost has been saved and passed on to the
Maryland and Mid-Atlantic Tennis Associations as well as to the Association
Of Maryland Tennis Officials and the Homeland Racquet Club. At one time, I
was an officer of all of them.

Then there are the folders labeled Jack Stahr and, Nick Powel. In 1976
through 1988, I served on the USTA Rules Committee when Jack Stahr, Nick
Powel and John Coman were Chairs. Talk about a Who’s Who of officiating
lore. Some of that history may be irreplaceable. It was a good time to
insure it got passed on.

I also started a journal of this whole knee thing using a notebook received
from Good Sam entitled JOINTEXperience. It’s possible that somewhere in the
back of my mind this column was beginning to formulate. I’m glad I did it
because it is surprising how much you forget which, in a way, is not all
that bad.

Naturally, I had books I wanted to read lined up and just to be on the safe
side, ordered subscriptions to the NY Times and, when the Washington Post
offered me a deal on a six month subscription, I got it too. Finally there
was nothing more left to do but go for it. Next column: New Knees.

Knee Replacement – Part IIIEarly Tuesday, September 7, 2010, I found myself being wheeled down a
series of halls into a well-lit, Star Wars-like operating room replete with
attendants in full transparent face masks. A few words with Dr. Jacob’s
Assistant, Jim Lathroum, and it was lights out for me. I awoke to a new
world.

That first day and into the second, I was hooked up to a morphine filled
pain pump and there was constant monitoring of my vital signs day and night;
especially the first few days following surgery. My vital signs were being
checked every 2-3 hours. There was no such thing as a good night’s sleep and
would not be for my whole time in the hospital and indeed for many weeks to
come. A few years earlier, I had played doubles against a good senior
player, David Maxwell, who had both knees replaced and I remember him saying
something to the effect that getting back on your feet after knee
replacement was a full time job for 4 months. During that time, your life is
on hold. Knowing what I know now, I can only say no truer words were spoken.
I was looking down a long road.

Therapy began the second afternoon and continued with twice-a-day sessions
after that. Each session was followed by ice. Ice was the order of the day –
and night – to keep the swelling and pain down. The importance of keeping
the knee from swelling cannot be over emphasized. For months after your
operation you will need to ice your knees.

My knee was only wrapped in light gauze and was checked constantly for any
sign of infection. When I first got a look at it, I was somewhat mystified
because I saw no sign of stitches or staples. It wasn’t pretty to look at,
of course, but it didn’t look as bad as I expected. Then I found out the
incision was held together by glue! As my grandmother would have exclaimed,
“What will they think of next!” Now, almost a year after the replacements,
you can hardly notice the scars. A real pro was at work. It’s not that I’ll
ever win a beautiful knees contest, but I have seen some ugly incisions in
my lifetime.

I was in bed for the first 24 hours after the operation, but then was able
to get up and use the bathroom. Any and all movement the first few weeks was
very deliberate and slow. Thankfully, my upper body was strong and I was
able to use a walker without too much trouble. But I was no gazelle. To help
move my leg in bed, I had a 3 foot strap with a handle on one end and a
loop around the other. Easy, boy! Any false move and I knew about it in a
hurry. I was also given a 2 foot grasping device to help reach objects just
out of reach. Talk about being helpless. To help matters, I wore pajamas cut
off at the knees. But I never even thought of trying to put the elastic
stretch socks or any other socks on by myself. My wife Gretchen was there
for me whenever I needed her. I’m a lucky guy. She even took out the
garbage.

In addition to blood thinner, vitamins and laxatives, I was on oxycodone, a
powerful opiate to kill pain. But after 3 days, I had enough of its La La
land effect and went on Tramadol which is like an opioid, but not as strong.
It worked fine. In a few weeks, I went to Tylenol and from there, enteric
aspirin. In every instance, I followed and even sought the pharmacologist’s
advice. For instance, two days after my second knee operation, the
pharmacologist, David Perly, came up with a special cocktail of pain
medication for me. I had told him of my concern about the affects of
Oxycodone. His effort really eased the pain. One thing you should keep in
mind, there is no need to suffer too much pain. Discomfort? Of course. It
comes with the territory. But not real pain.

On doctor’s advice, I stayed over the weekend so I could have therapy and
then on September 14, a week to the day I had my left knee replaced, the
right leg received its new joint. Deja vu all over except this time there
were two knees to contend with instead of one. In for a penny, in for a
pound. It wasn’t that bad. For one thing, I knew what to expect and for the
other, I knew the worst was behind me – sort of.

One thing I had not counted on was the almost total lack of appetite that
stayed with me for about 5 weeks. Nothing appealed to me. Nothing. Not even
a beer. In fact, I refrained from alcohol for about 5 weeks. No sense in
asking for trouble with the meds I was taking. I knew, of course, that I
had to have nourishment, so went to nutritional supplements like Ensure and
milk shakes. I must have had several gallons of milk shakes during this
period. The magic moment came when I was at Mike Morrison’s (my friend and
double’s partner) watching the Ravens. Mike had gone to Miller’s Deli in
Pikesville and gotten corned beef sandwiches for us. I demolished mine. That
sandwich seemed to trigger my appetite and I began to regain some of the
weight I had lost. How much weight went? Probably about 20 pounds. I kept
the string on my pajamas pretty tight.

That Friday afternoon, September 17, ten nights after admission to Good Sam,
I went home and as I got in the house experienced a Dorothy moment. Not far
behind me were a visiting nurse and physical therapist. I wasn’t out of the
woods by a long shot. There is a good reason for all that attention. Your
body is in a weakened condition (in all, I had 4 blood transfusions) and
there is a real danger of blood clots and infection hanging over your head
like a Sword of Damocles. Nor do they want your knees to stiffen so that you
do not receive the full benefit of your new knees. Your medical team has
gotten you this far. They want to see you go all the way.

The following couple weeks were a blur. Movement was difficult and often
painful. Getting in and out of bed and my chair was an ordeal. I made good
and frequent use of the 3 foot strap to help move my legs and a mechanical
arm for grabbing objects just out of reach. Icing was a constant routine as
was elevating my legs for 20 minutes at a time. At least twice a day, I did
the exercises prescribed for my knees and then pushed the walker around the
house for awhile. Clump. Clump. Clump.

Got a call from Barry Grube on September 25 following up on an invite he had
sent to a party at Cross Keys Tennis Club celebrating the 20th running of
the Century Tournament he started way back then. It really hurt to turn it
down, but I was in no shape for any kind of party, even one as attractive as
that. But it did bring back pleasant memories of playing in it; especially
the first one held. A member of my Saturday indoor group at Cross Keys, Ham
Easter, and I entered. We got to the finals against two outstanding senior
players, Norm Fitz from Silver Spring and Morty Greenberg. If you haven’t at
least heard of Mort, the Sport, you don’t know much about local tennis
history. Ham, on the other hand, wasn’t too well known, but those of us that
did had the utmost respect for his game. A good serve and volleyer, Ham had
a great forehand and just about never missed an overhead. Sometimes you just
click and we did that match, not losing a single game. Ham Easter, a
genuinely nice guy remembered.

Toward the end of September, I was discharged from home care and on the
30th, began out-patient therapy with the Union Memorial Sports Medicine
Clinic at York and Seminary. I was no stranger to it. For years, its
manager, Steve Frantz, has kept me on court by healing the injuries a
lifetime of sports inflicts on the body. I could not have more faith and
confidence in anyone else. We are friends. When I saw Steve, I mentioned
that I was feeling achy that morning and he laughed and said, “it’s
raining.” The realization came to me that I was my grandparents who also use
to complain about aches and pains when it rained and I had to laugh with
him. Then we began the long haul to put me back on my feet and on the court.

The week of October 17, about 6 weeks after my first replacement, was a
memorable one. That Sunday, I drove to Orchard Indoor and watched my Sunday
group play. I had not driven before that because I wanted to be sure my legs
were strong enough to do so safely. Just the day before, I had put the
walker away for good. Once behind the wheel, it was old home week. From that
point on, things picked up.

Two days later, I had breakfast at the Nautilus Diner (where George Hoche
holds reign) with the ‘boys’ and that night dropped in to see the gang at my
watering hole, Racers, on Harford Road. And on the 23rd, I went off all
drugs associated with my knees. Things were looking up, but I was far from
being out of the woods.

Knees – Part IVThe long out-patient therapy haul began on September 30, 2010 and ended
almost four months later. Usually, it involved twice-a-week sessions with
Steve Frantz at the Union Memorial Sports Medicine Clinic at York and
Seminary in Towson. Easy does it is Steve’s modus operandi and I can tell
you from bitter experience, the times I pushed on my own paid off in pain
and set-back. None of it was intentional, but twice I was feeling really
good during my 20 minute, twice-a-day workouts at home and overdid it.

The sessions with Steve usually started with 10 minutes on the bicycle with the
length of the pedals adjusted to accommodate knee range of motion. Then a
quad-strengthening exercise followed by hands-on knee massage and bending.
Then an ice-down. The importance of keeping swelling down can not be
over-emphasized. For the most part, I used gel packs, sometimes 4-5 times
a day; sometimes 2-3 times a night. Swelling involved a constant battle.
The range of motion for my left knee was great – about 110% – but the right
was a different story. You would not have thought they were attached to the
same body.

But there was a good reason for this difference. The left knee
was replaced September 7, and on September 14 when the right knee was
replaced, a procedure called “manipulation” was performed on the left knee
while I was out for the count. Manipulation involves manually straightening
and bending the knee to break loose scar tissue and lesions. It’s usually an
out-patient procedure performed in an operating room.

On Tuesday, November 9 at 6 AM, I again found myself at Good Sam Hospital. I
had seen Dr. Jacobs a couple weeks before and he had advised manipulation
for the right knee. The usual pre-op checks and procedures were performed
and shortly after 7 o’clock, I again found myself in an airy hospital gown
being wheeled down the hallways into the operating room. There, I was
greeted by the familiar and friendly face of Jim Lathroum, Dr. Jacobs’ able
right hand man. The usual lights out effect of the anesthesia followed and
the next thing I knew, it was 7:30 and I was already back in recovery. Those
guys don’t fool around. That afternoon and for the next two days, Steve
worked on the knee. Physical therapy is important after manipulation to keep

the knee loose.

For whatever reason, the expected results didn’t happen. Although the knee
was now over 90 percent, the expectation was higher. Part of it was probably
my fault. The weekend after the manipulation, I worked out on my own flexing
the knees and was really happy with the progress I thought was being made.
The next day, both knees were stiffer than a board. I piled on the ice to
keep the swelling down and took an oxycodone for the pain. Frustration can
only begin to describe my feelings. Here I was trying to do my best to get
on my feet and…. Although he didn’t have to tell me, he did. Steve said,
“Don’t push.” Yes, Sir!

Six weeks after the second knee was replaced, I was feeling good enough to
get out. I attended the Official’s Meeting at the Maryland Tennis
Association Annual Meeting and stayed for the dinner after. Then I attended
Pam Shriver’s Celebration at the downtown Sheraton. That was a very special night
for a very special person in Maryland tennis history. There I ran into
Charlie and Mary Jane Macgill along with the Capras. The Macgills were a top
ranked mixed doubles team back when I was playing MXD. Needless to say, they
are very proud of their granddaughter, Beatrice Capra. Charlie and I go way
back. In 1976, we spent many a night piloting a computer ranking program
from the Texas Tennis Association that Mid-Atlantic ended up using for all
its rankings. Always nice to run into old friends. And of course, Billy
Jean, Martina and Chris helped make a special night even more special. You
have to love tennis people and the lengths they will go for each other.

At each event, I had to leave early. Being on my feet, even for a short
while, was tough and the knees started crying for ice. But better days were
ahead.

By the end of November, the left knee, at 120 degrees, no longer
needed attention. Steve had the right knee at 96 on Monday, November 29, but
on Friday of that week, it was only one degree better. I could not count on
progress being linear, but progress was being made. And although Steve did
not have to remind me, he did. Don’t push!

It wasn’t only me who was having this uneven, seemingly interminably slow
progress. Comparing notes with others going through the same process found
we were sharing similar experiences. I was beginning to wonder if the right
knee would ever hit 100 degrees, let alone 120. But on December 10, the 100
mark was reached and 2 weeks later, 110. By the end of December, the knee
was at 115 degrees, boding well for the new year.

Two things that helped were an emphasis on stretching the quads as well as
the knee and an exercise Dr. Jacobs prescribed involving my office chair. I
would plant my two feet flat in front of me and then roll the chair forward
as far as I could. Simple as it was, it helped. And through it all was
Steve’s calm, reassuring, confident manner. It all paid off. On January 19,
the right knee checked out at 123 degrees and my therapy was ended. Next:
Final chapter – back playing.